Healthcare Provider Details

I. General information

NPI: 1720140866
Provider Name (Legal Business Name): LAVELLS TRANSPORT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5767 N 98TH ST
MILWAUKEE WI
53225-2507
US

IV. Provider business mailing address

5767 N 98TH ST
MILWAUKEE WI
53225-2507
US

V. Phone/Fax

Practice location:
  • Phone: 414-464-3686
  • Fax: 414-464-5332
Mailing address:
  • Phone: 414-464-3686
  • Fax: 414-464-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number41473200
License Number StateWI

VIII. Authorized Official

Name: MR. TORRANCE LAVELL EVANS
Title or Position: PRESIDENT
Credential:
Phone: 414-464-3686